Endovascular Versus Open Repair for Symptomatic, Non-Ruptured Abdominal Aortic Aneurysms: A Retrospective Cohort Study

Abstract

Objective: To compare perioperative organ morbidity, 30-day mortality, and 5-year overall survival following endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) for symptomatic, non-ruptured abdominal aortic aneurysm (SnAAA). Materials and Methods: We retrospectively reviewed 140 consecutive patients treated for SnAAA between 2010 and 2020 (EVAR n=111, OSR n=29). The primary endpoint was 30-day all-cause mortality; secondary endpoints included perioperative complications and 5-year survival. Due to extreme baseline imbalances (62.2% unfit in EVAR vs 6.9% in OSR) and limited sample size, multivariable adjustment was used instead of propensity score methods. Results: Thirty-day mortality was 1.8% in the EVAR group and 3.4% in the OSR group (p=0.504, Fisher’s exact test). EVAR was associated with an 88% reduction in perioperative organ complications (adjusted OR 0.12, 95% CI 0.03-0.47, p=0.003), including a significant reduction in respiratory failure (2.7% vs 13.8%, OR 0.17, 95% CI 0.04-0.83, p=0.034). EVAR also resulted in shorter operative time (median 150 vs 265 minutes, p<0.001), reduced blood loss (200 vs 1,800 mL, p<0.001), and shorter hospital stay (7 vs 11 days, p<0.001). Five-year survival analysis revealed no significant difference between groups (log-rank p=0.193; adjusted HR 1.09, 95% CI 0.42-2.85, p=0.857). Conclusions: Despite being performed in a higher-risk cohort, EVAR provided significant protection against organ complications without compromising long-term survival compared to OSR. These findings support EVAR as the preferred approach for unfit patients with SnAAA, while both strategies remain appropriate options for fit patients.